A mixed-method review on greenwashing: its manifestation forms and “3p” greenwashing’s theoretical framework

To assess the effectiveness of supervised toothbrushing programs in improving oral health outcomes among children and adolescents aged 3 to 18 years and to explore stakeholders' perceptions in implementing and sustaining tooth brushing programs. This mixed-method umbrella review followed JBI methodology and PRISMA guidelines. A systematic search was conducted across databases including MEDLINE, Cochrane, Scopus, Web of Science, CINAHL, Epistemonikos, ProQuest, and Google Scholar. A total of 159 articles were identified, and after screening, three systematic reviews met the inclusion criteria. The quantitative and qualitative findings were synthesized using a convergent segregated approach. The Theoretical Domains Framework (TDF) was applied to map barriers and facilitators influencing program adoption and sustainability. The quantitative synthesis included one systematic review with four included trials, two of which found statistically significant reductions in dental caries with supervised toothbrushing. The qualitative synthesis (two mixed-method systematic reviews) revealed key facilitators and barriers. The most prominent enablers and barriers identified across these reviews were knowledge about oral health/tooth brushing, social influences, and environmental context and resources. Specifically, the knowledge domain received 32 enabler responses and 25 barrier responses, underscoring the importance of understanding oral health practices to improve toothbrushing behavior. Social support garnered 35 enabler responses and 26 barrier responses, highlighting the role of a supportive environment in enhancing adherence to toothbrushing routines. This review highlights the effectiveness of supervised toothbrushing programs in reducing dental caries. The qualitative synthesis, guided by the Theoretical Domains Framework (TDF), identifies key barriers and facilitators, including knowledge gaps, environmental constraints, social influences, and behavioural regulation factors.

Medication non-adherence is a well-recognised issue in chronic diseases but data in patients with chronic kidney disease (CKD) not receiving kidney replacement therapy (KRT) remains limited. This review summarised the prevalence of medication non-adherence and assessed determinants and outcomes associated with it in adults with CKD, not on KRT. We searched PubMed, Embase, PsychInfo, Web of Science, and Cochrane (CENTRAL) for studies published until January 2020. Pooled prevalence of medication non-adherence was reported. Determinants of adherence-identified from quantitative and qualitative studies-were mapped into the theoretical domains framework and interventions proposed using the behavioural change wheel. Twenty-sevenstudies (22 quantitative and 5 qualitative) were included. The pooled prevalence of medication non-adherence was 39% (95% CI 30-48%). Nine studies reported association between non-adherence and outcomes, including blood pressure, disease progression, adverse events, and mortality. Modifiable determinants of non-adherence were mapped into 11 of the 14 Theoretical Domains Framework-of which, six appeared most relevant. Non-adherence decisions were usually due to lack of knowledge on CKD, comorbidities, and medications; polypharmacy and occurrence of medication side effects; changes in established routines such as frequent medication changes; higher medication cost, poor accessibility to medications, services and facilities; inadequate patient-healthcare professional communication; and forgetfulness. Using the behavioural change wheel, we identified several areas where interventions can be directed to improve medication adherence. Medication non-adherence is common in adults with CKD, not on KRT and may lead to poor outcomes. Evidence synthesis using mixed study designs was crucial in identifying determinants of non-adherence, drawing on a parsimonious approach from behaviour science. CRD42020149983.

Early cancer detection is crucial for patient outcomes. Clinical Decision Support Systems (CDSS) have been developed to assist with decision-making about screening or symptomatic assessment in primary care, but implementation remains challenging. The aim of this study was to compare barriers to implementation of cancer-specific CDSS for screening and symptomatic presentation in primary care. Systematic mixed-methods literature review. We conducted a sub-analysis within a systematic review. Qualitative and quantitative data on barriers were coded into themes guided by the Theoretical Domains Framework. Frequencies of studies mentioning barriers were compared between CDSS for cancer detection and other conditions, and between cancer-CDSS for screening and symptomatic presentation. 29 cancer-specific CDSS were identified, addressing screening (n=15) and symptomatic presentation (n=14), with a further 70 addressing other conditions. There were minimal differences in barriers for cancer-specific CDSS and other CDSS. There were differences between cancer-specific CDSS for screening and symptomatic presentation. Barriers more frequently reported for CDSS for symptomatic presentation involved workflow integration (n=9, 64% vs n=4, 27%), medicolegal uncertainty (n=4, 29% vs n=0, 0%), requirements of skills (n=7, 50% vs n=2, 13%), interference with decision-making processes (n=6, 43% vs n=2, 13%), and negative emotions (n=8, 57% vs n=4, 27%). The function and healthcare context of CDSS in the diagnostic process (symptomatic assessment or screening decision-making) appears to be more relevant to implementation than the targeted condition. Involving stakeholders to clarify medicolegal issues and workflow integration is essential for the implementation of CDSS for symptomatic presentation.

The emergence of smart technologies has brought substantial changes in logistics. Hence, understanding smart technologies applied in logistics has become critical for practitioners and scholars to make smart technologies better empower logistics activities. Because research on this issue is new and largely fragmented, it will be theoretically essential to evaluate what has been studied and derive meaningful insights through a literature review. In this study, we conduct a mixed-method literature review of smart technologies in logistics. We classify these studies by topic modeling and identify important research domains and methods. More importantly, we draw upon the task-technology fit theory and logistics activities process to propose a multi-level theoretical framework in smart technologies in logistics for understanding the current status in research. We believe that this framework can provide a valuable basis for future logistics research.

Examined from Bio-Ecological System Theory’s PPCT model perspective, this study systematically reviewed how youth sport dropout literature has been theoretically framed; how dropout has been defined and measured; and, mapped all influential factors previously associated (or not) with dropout across and within youth sport. Peer-reviewed literature (N = 69 studies) published over four decades (1980–2021) residing within five databases was synthesised using a mixed-methods review approach. Existing identified studies examined single or multi-sport (male and female) youth sport contexts worldwide, at different participation levels, although predominantly local club-level. Prior studies predominantly adopted psychological-based theoretical frameworks; often didn’t define dropout; assessed dropout descriptively; and, focused upon the influence of psychological-based factors. From a PPCT perspective, competition structure, relative age (Process), sex, competence perception (Personal), parental socio-demographics, and conflicts with other activities (Context) were frequently identified as influential to dropout across contexts. Although not explicitly utilising the PPCT, sixteen studies examined factors across PPCT levels, with one identifying significant independent influences across the model. Future research is recommended to apply more encompassing (social-ecological) theoretical frameworks; specify dropout definitions and measures; and apply more advanced analytical methods. To help improve study methodological quality, the ‘Youth Sport Dropout - Study Checklist (YSD-SC)’ is presented.

Background/Objectives: Heart failure assistance is strictly correlated with the concept of palliative care. Supportive treatment should be part of the heart failure patient pathway from the beginning. Palliative care with interprofessional effective collaboration could be an important resource used to reduce heart failure distressing symptoms and improve quality of life. Nurses, as professionals with a holistic vision of care, play a crucial role in palliative care introduction and implementation. The aim was to explore nurses' attitudes and perceptions of heart failure palliative care, updating and adding knowledge to the current evidence. Methods: A systematic mixed-method review following the Joanna Briggs Institute methodology was undertaken. The screening of articles, data extraction and quality appraisal were performed by more than one author. The search was undertaken in May 2024 and applied to PubMed, Cinahl, Embase, Web of science, PsycInfo, Cochrane library and Scopus. A convergent integrated approach allowed us to combine qualitative and quantitative data. The analysis and synthesis of results was guided by the Theoretical Domain Framework. Results: Of the 1048 records identified, 26 met the inclusion criteria. Twelve framework domains were completed with data extracted. A flow chart was elaborated to offer an overview of the main concepts included. Conclusions: Numerous behaviors and elements influenced heart failure palliative care implementations. Analysis has shown that each analyzed element was strictly correlated one with another. When implementation was possible, outcome improvement sustained palliative care benefits with the direct involvement of nurses as educators and coordinators.

The behavioural determinants of health among people with mild/moderate intellectual disabilities (ID) are of increasing concern. With the closure of long-stay institutions, more people with ID are living in the community. As they lead more ordinary and less restricted lives, people with ID may be exposed to social and environmental pressures that encourage them to adopt behaviours that impact negatively on their health. Levels of smoking and alcohol consumption in this client group are of particular concern. We undertook a mixed method review of the literature, aiming to assess the Feasibility, Appropriateness, Meaningfulness and Effectiveness (FAME) of interventions designed to address the use of tobacco and/or alcohol in people with mild/moderate ID. Key electronic databases were searched (e.g., Medline, Cochrane Register of Controlled Trials, PsycINFO) from 1996 to 2011. The search was developed using appropriate subject headings and key words (e.g., intellectual disability, tobacco use, alcohol drinking, health promotion). On completion of the database searches, inclusion/exclusion criteria, based on an adaptation of the PICO framework (Population, Intervention, Comparison, Outcomes), were applied. Methodological quality was assessed using a seven-point rating scale. Database searches identified 501 unique records, of which nine satisfied the inclusion criteria. Four focused on tobacco, three on alcohol and two on both tobacco and alcohol. Located in the U.K., the U.S.A. and Australia, the studies aimed to increase knowledge levels and/or change behaviour (e.g., to encourage smoking cessation). One was a randomised controlled trial, one a quasi-experiment and the others were before and after studies and/or case studies. Methodological quality was poor or moderate. The combined studies had a sample size of 341, with ages ranging from 14 to 54 years. The interventions were delivered by professionals (e.g., in health, social care, education) during sessions that spanned a period of three weeks to one academic year. The studies highlighted a number of important issues linked to the appropriateness of interventions for this client group (e.g., use of pictures, quizzes, role play, incentives); however, in the majority of cases the interventions appeared to lack a theoretical framework (e.g., behaviour change theory). The appropriateness of the outcome measures for use with this client group was not tested. One study discussed feasibility (teachers delivering lessons on alcohol and tobacco) and only one was informative in terms of effectiveness, i.e., increasing knowledge of the health and social dangers of smoking and excessive alcohol consumption. This review is the first to systematically collate evidence on tobacco and alcohol-related interventions for people with ID. While there is currently little evidence to guide practice, the review delivers clear insights for the development of interventions and presents a strong case for more robust research methods. In particular there is a need to test the effectiveness of interventions in large-scale, well-designed trials and to ensure that outcome measures are developed/tailored appropriately for this client group.

As global challenges intensify, integrating sustainability into STEM education and careers is urgent. We conducted a convergent mixed-methods review that combines scientometric and narrative approaches. Scientometric analyses help map the macro-level scope of the field—tracking publication trends, identifying dominant clusters, and pinpointing emerging areas. Narrative reviews offer complementary depth, revealing how specific research methods and theoretical frameworks shape our understanding of sustainability within STEM. The scientometric analysis encompassed 2721 publications from 1992 to February 2025, utilizing CiteSpace and VOSviewer for mapping. In addition, a narrative synthesis was conducted on 113 studies selected through title and abstract screening. Scientometric analysis shows a post-2010 surge in sustainability-focused STEM work, coalescing into four clusters: (1) education and technology integration, (2) human factors and institutional structures, (3) sustainability and policy, and (4) innovation and economic impact. Narrative findings identify three dominant methodological traditions (quantitative, qualitative, and mixed) and five recurrent theoretical lenses (SCCT, identity, SDT, ecological systems, and integrated models). Triangulation reveals three persistent gaps: (i) limited research in non-Western contexts, (ii) scarce longitudinal studies following learners into early careers, and (iii) weak integration of person-centred and structural theories. Together, the two strands provide a roadmap for context-sensitive, interdisciplinary, and longitudinal inquiry that can better equip the global STEM workforce to advance sustainability.